From the Guidelines
Breast MRI is indicated for women at higher-than-average risk of breast cancer, including those with a calculated lifetime risk of 20% or more, personal histories of breast cancer, or those diagnosed before age 50, and should be performed annually beginning at age 30. According to the American College of Radiology recommendations 1, annual surveillance with breast MRI is recommended for women with personal histories of breast cancer and dense breast tissue, or those diagnosed before age 50. For women with genetics-based increased risk, MRI should be considered, especially if other risk factors are present 1. The procedure involves lying face down on a specialized table with breasts positioned in dedicated coils, and requires intravenous contrast (gadolinium) 1. Some key points to consider when recommending breast MRI include:
- Women with a strong family history of breast cancer, BRCA1/2 gene mutations, or those who received chest radiation before age 30 may benefit from supplemental screening with breast MRI 1
- MRI offers superior sensitivity compared to mammography, especially in dense breast tissue, but has lower specificity which can lead to unnecessary biopsies
- Insurance coverage typically requires meeting high-risk criteria, and patients should check with their provider before scheduling
- Those with kidney problems, metal implants, claustrophobia, or gadolinium allergies may not be candidates for breast MRI. It's essential to weigh the benefits and risks of breast MRI, especially for women with elevated risk limited to increased breast density, and consider adjunctive screening with ultrasound if necessary 1.